case 7 - diabetic kidney disease Flashcards
what is the basic membrane comprised of
glomerular
Tubular
Bowman’s Capsule
what is the interstitial membrane comprised of
mesangium
Tubulointerstitium
what are the different cellular and matrix defects
matrix expansion
Sclerosis
Podocyte detachment
Mesangial cell proliferation
what would a urine dipstick show
a protien leak
what is the most common type of proteinuria
glomerular
what is glomerular proteinuria
most common, up to 90%
Feature of chronic kidney disease
Loss of albumin and higher molecular weight proteins
what is tubular proteinuria
low molecular weight proteins such as beta2-microglobulin
what is overflow proteinuria
increased production that is light chains in multiple myeloma
what is post-exercise proteinuria
transient benign
Can be up to 10g/day
what is post-pradial proteinuria
transient physiological proteinurinia
Possibly through insulin action in podocytes
what is infection associated proteinuria
physiological response
Mediated by toll-receptors
Possibly involved in clearing pathogens from the circulation
what is normal PCR and what is the nephrotic range
*Protein:creatinine ratio (PCR)
–<20mg/mmol (normal)
–200mg/mmol (nephrotic range)
what is the ACR normal value and what value suggests albuminuria
–>3 mg/mmol (microalbuminuria)
–>30 mg/mmol (albuminuria)
what are the stages of injury in diabetic nephropathy
hyperfiltration
Microalbuminuria
Microalbuminuria
Proteinuria
Declining renal function
what is the pathology behind diabetic nephropathy
Glomerular;
GBM thickening
Mesangial expansion
Nodular sclerosis
Advanced sclerosis
tubule-interstitial
Vascular
what are the treatment goals and what is used
*Glycaemic control
*Blood pressure control
*RAAS blockade ACEi/ARB
–RENAAL T2DM Losartan
–Also in normotensive T1DM
–Aliskiren renin inhibitor
*Lipid lowering
*Reduce other CV risks
what do diuretics do
reduce extracellular fluid
Lower blood pressure
Augment effects of RAAS inhibitors
Choice of diuretic agent depends on renal function
Thiazide and loop diuretics
what is renal replacement therapy
Peritoneal dialysis
immediate use reduces fluid overload
No anticoagulation
Cheapest
Global application
continuous
Least likely to cause fluid shifts and hypotension
what is haemodialysis and haemofiltration
specialist nursing care
Tertiary units
Need for good central venous access
High and efficient solute clearance
Anticoagulation
Intermittent; not tolerated when haemodynamically unstable
Continuous: haemofiltration
